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Mittermair C, Weiss M, Schirnhofer J, Brunner E, Fischer K, Obrist C, de Cillia M, Kemmetinger V, Gollegger E, Hell T, Weiss H. The Shift from Multiport to Single Port Increases the Amount of Bleeding in Laparoscopic Major Hepatectomy. J Clin Med 2021; 10:jcm10030374. [PMID: 33498169 PMCID: PMC7863947 DOI: 10.3390/jcm10030374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/02/2021] [Accepted: 01/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible benefits for the patient. This study was conducted to assess hemostasis techniques in single-port major hepatectomies (SP-MajH) as compared to multiport major hepatectomies (MP-MajH). Methods: The non-randomized study comprised 34 SP-MajH in selected patients; 14 MP-MajH served as the control group. Intraoperative blood loss and number of blood units transfused served as the primary endpoints. Secondary endpoints were complications and oncologic five-year outcome. Results: All resections were completed without converting to open surgery. Time for hepatectomy did not differ between SP-MajH and MP-MajH. Blood loss and number of patients with blood loss > 25 mL were significantly larger in MP-MajH (p = 0.001). In contrast, bleeding control was more difficult in SP-MajH, resulting in more transfusions (p = 0.008). One intestinal laceration (SP-MajH) accounted for the only intraoperative complication; 90-day mortality was zero. Postoperative complications were noted in total in 20.6% and 21.4% of patients for SP-MajH and MP-MajH, respectively. No incisional hernia occurred. During a median oncologic follow-up at 61 and 56 months (SP-MajH and MP-MajH), no local tumor recurrence was observed. Conclusions: SP-MajH requires sophisticated techniques to ensure operative safety. Substantial blood loss requiring transfusion is more likely to occur in SP-MajH than in MP-MajH.
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Affiliation(s)
- Christof Mittermair
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
| | - Michael Weiss
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
| | - Jan Schirnhofer
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
| | - Eberhard Brunner
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
| | - Katharina Fischer
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
| | - Christian Obrist
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
| | - Michael de Cillia
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
| | - Vanessa Kemmetinger
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
| | - Emanuel Gollegger
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
| | - Tobias Hell
- Department of Mathematics, University of Innsbruck, Technikerstrasse 13, 6020 Innsbruck, Austria;
| | - Helmut Weiss
- Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; (C.M.); (M.W.); (J.S.); (E.B.); (K.F.); (C.O.); (M.d.C.); (V.K.); (E.G.)
- Correspondence: ; Tel.: +43-(0)662-8088-8422; Fax: +43-(0)662-8088-77222
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Nerup N, Rosenstock S, Bulut O. Comparison of single-port and conventional laparoscopic abdominoperineal resection. J Minim Access Surg 2018; 14:27-32. [PMID: 28782746 PMCID: PMC5749194 DOI: 10.4103/jmas.jmas_38_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Within the last two decades, surgical treatment of colorectal cancer has changed dramatically from large abdominal incisions to minimal access surgery. In the recent years, single port (SP) surgery has spawned from conventional laparoscopic surgery. The purpose of this study was to compare conventional with SP laparoscopic abdominoperineal resection (LAPR) for rectal cancer. Patients and Methods: This was a single-center non-randomised retrospective comparative study of prospectively collected data on 53 patients who underwent abdominoperineal resection for low rectal cancer; 41 with conventional laparoscopy and 12 with SP surgery. Results: Patients’ characteristics were in general comparable, but patients in the conventional laparoscopy-group had a significantly higher American Society of Anesthesiologists-score. The operative time was slightly shorter in the conventional laparoscopy-group, but no differences were found in oncological margins of the resected specimen, in length of stay or readmission rate. Conclusions: SP LAPR appeared to be safe and feasible in selected patients. Adequate oncologic resections can be performed with acceptable morbidity and mortality. Larger randomised controlled trials with longer follow-up are needed to determine the beneficial role of this new procedure.
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Affiliation(s)
- Nikolaj Nerup
- Department of Surgical Gastroenterology, Copenhagen University Hospital Hvidovre, Kettegaards allé 30, DK-2650 Hvidovre, Denmark
| | - Steffen Rosenstock
- Department of Surgical Gastroenterology, Copenhagen University Hospital Hvidovre, Kettegaards allé 30, DK-2650 Hvidovre, Denmark
| | - Orhan Bulut
- Department of Surgical Gastroenterology, Copenhagen University Hospital Hvidovre, Kettegaards allé 30, DK-2650 Hvidovre, Denmark
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Weiss H, Mittermair C, Weiss M. [Single incision laparoscopy : Current status]. Chirurg 2017. [PMID: 28623455 DOI: 10.1007/s00104-017-0446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since the introduction of single incision laparoscopy (SIL), there has been disagreement among professional societies regarding a general recommendation for the use of this minimally invasive method. OBJECTIVES Determination of evidence-based advantages of SIL compared to multiport laparoscopy (MPL). MATERIALS AND METHODS Description of recent technical developments and evaluation of prospective randomized clinical trials and valid meta-analyses with regard to organ-specific procedures. In addition, an expert opinion is provided based on 4209 SIL interventions. RESULTS SIL is nowadays applied in all fields of general and visceral surgery. Due to the initial enthusiasm, methodologically weak studies were often published in the literature. Any beneficial effect of SIL on reduced perioperative morbidity is not clearly confirmed, yet. A better cosmetic outcome is either obvious (in SIL liver resections) or nearly unverifiable (in SIL cholecystectomies). CONCLUSION SIL has proven feasible and safe after getting through the learning curve. Scientific evidence is currently insufficient to justify SIL without reservation in particular without the individual technical experience of the surgeon.
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Affiliation(s)
- H Weiss
- Abteilung für Chirurgie, A. ö. Krankenhaus der Barmherzigen Brüder, Kajetanerplatz 1, 5010, Salzburg, Österreich. .,Lehrabteilung, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Österreich. .,Lehrabteilung, Medizinische Universität Innsbruck (MUI), Innsbruck, Österreich. .,Lehrabteilung, Medizinische Universität Wien (MUW), Wien, Österreich.
| | - C Mittermair
- Abteilung für Chirurgie, A. ö. Krankenhaus der Barmherzigen Brüder, Kajetanerplatz 1, 5010, Salzburg, Österreich.,Lehrabteilung, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Österreich.,Lehrabteilung, Medizinische Universität Innsbruck (MUI), Innsbruck, Österreich.,Lehrabteilung, Medizinische Universität Wien (MUW), Wien, Österreich
| | - M Weiss
- Abteilung für Chirurgie, A. ö. Krankenhaus der Barmherzigen Brüder, Kajetanerplatz 1, 5010, Salzburg, Österreich.,Lehrabteilung, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Österreich.,Lehrabteilung, Medizinische Universität Innsbruck (MUI), Innsbruck, Österreich.,Lehrabteilung, Medizinische Universität Wien (MUW), Wien, Österreich
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